The role of hand-assisted laparoscopic surgery in subtotal and total colectomy for Crohn’s colitis

Nakajima, Kiyokazu; Nezu, Riichiro; Hirota, Masaki; Nishida, Toshirou

doi:10.1007/s00464-010-1031-0

Cited by 23 publications

(17 citation statements)

References 12 publications

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“…Two studies [33,40] included patients undergoing both hand assisted laparoscopic surgery and laparoscopic assisted surgery. These two groups were analyzed together in the laparoscopic surgery group.…”

Section: Resultsmentioning

confidence: 99%

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Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

Patel

Ramagopalan

et al. 2013

BMC Surg

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BackgroundPrevious meta-analyses have had conflicting conclusions regarding the differences between laparoscopic and open techniques in patients with Crohn’s Disease. The objective of this meta-analysis was to compare outcomes in patients with Crohn’s disease undergoing laparoscopic or open surgical resection.MethodsA literature search of EMBASE, MEDLINE, The Cochrane Central Register of Controlled Trials and the US National Institute of Health’s Clinical Trials Registry was completed. Randomized clinical trials and non-randomized comparative studies were included if laparoscopic and open surgical resections were compared. Primary outcomes assessed included perioperative complications, recurrence requiring surgery, small bowel obstruction and incisional hernia.Results34 studies were included in the analysis, and represented 2,519 patients. Pooled analysis showed reduced perioperative complications in patients undergoing laparoscopic resection vs. open resection (Risk Ratio 0.71, 95% CI 0.58 – 0.86, P = 0.001). There was no evidence of a difference in the rate of surgical recurrence (Rate Ratio 0.78, 95% CI 0.54 – 1.11, P = 0.17) or small bowel obstruction (Rate Ratio 0.63, 95% CI 0.28 – 1.45, P = 0.28) between techniques. There was evidence of a decrease in incisional hernia following laparoscopic surgery (Rate Ratio 0.24, 95% CI 0.07 – 0.82, P = 0.02).ConclusionsThis is the largest review in this topic. The results of this analysis are based primarily on non-randomized studies and thus have significant limitations in regards to selection bias, confounding, lack of blinding and potential publication bias. Although we found evidence of decreased perioperative complications and incisional hernia in the laparoscopic group, further randomized controlled trials, with adequate follow up, are needed before strong recommendations can be made.

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Section: Resultsmentioning

confidence: 99%

“…These resections included ileocecal resection, other small bowel resections, segmental colectomy and subtotal colectomy. Three studies [17,33,41] (20, 32, 39) looked exclusively at patients undergoing colectomy for Crohn’s colitis.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

Patel

Ramagopalan

et al. 2013

BMC Surg

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“…Several advantages of the hand-assisted approach were emphasized: the inserted hand can provide blunt dissection, tactile feedback from the hand helps to identify lesions that are not clearly visible, and better control of bleeding and better organ retraction are possible. HALS, therefore, represents a useful alternative to SLS [6, 11] and may be considered as a new method for more complex procedures or more difficult pathologies [7, 12, 13]. However, the best use for HALS is laparoscopy-assisted surgery in which an additional incision is required for extracting the specimen.…”

Section: Discussionmentioning

confidence: 99%

The Role of Hand-Assisted Laparoscopic Surgery in a Right Hemicolectomy for Right-Sided Colon Cancer

et al. 2014

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PurposeThe purpose of this study is to evaluate the perioperative and long-term oncologic outcomes of hand-assisted laparoscopic surgery (HALS) and standard laparoscopic surgery (SLS) and assess the role of HALS in the management of right-sided colon cancer.MethodsThe study group included 53 patients who underwent HALS and 45 patients who underwent SLS for right-sided colon cancer between April 2002 and December 2008.ResultsThe patients in each group were similar in age, American Society of Anesthesiologist (ASA) score, body mass index, and history of previous abdominal surgeries. Eight patients in the HALS group and no patient in the SLS group exhibited signs of tumor invasion into adjacent structures. No differences were noted in the time to return of normal bowel function, time to toleration of diet, lengths of hospital stay and narcotic usage, and rate of postoperative complications. The median incision length was longer in the HALS group (HALS: 7.0 cm vs. SLS: 4.8 cm, P < 0.001). The HALS group had a significantly higher pathologic TNM stage and significantly larger tumor size (HALS: 6.0 cm vs. SLS: 3.3 cm, P < 0.001). The 5-year overall, disease-free, and cancer-specific survival rates of the HALS and the SLS groups were 87.3%, 75.2%, and 93.9% and 86.4%, 78.0%, and 90.7%, respectively (P = 0.826, P = 0.574, and P = 0.826).ConclusionAlthough patients in the HALS group had more advanced disease and underwent more complex procedures than those in the SLS group, the short-term benefits and the oncologic outcomes between the two groups were comparable. HALS can, therefore, be considered an alternative to SLS for bulky and fixed right-sided colon cancer.

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“…Hand‐assisted laparoscopic surgery (HALS) has recently gained clinical acceptance as a practical and useful alternative technique to laparoscopic and open surgery 13–16. HALS is not only less invasive than open surgery but also causes less damage to organs and is easier than laparoscopic surgery based on its manual nature and ability to use retractors.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive esophagectomy for esophageal cancer: Comparative analysis of open and hand‐assisted laparoscopic abdominal lymphadenectomy with gastric conduit reconstruction

Yamasaki

Miyata

Fujiwara

et al. 2011

Journal of Surgical Oncology

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The role of hand-assisted laparoscopic surgery in subtotal and total colectomy for Crohn’s colitis

Abstract: The findings showed that HALS subtotal and total colectomies are feasible and safe. The HALS procedure currently seems potentially beneficial for patients with extensive Crohn's colitis by reducing the operative time for laparoscopic surgery while retaining its less invasiveness.

Cited by 23 publications

References 12 publications

Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

Laparoscopic surgery for Crohn’s disease: a meta-analysis of perioperative complications and long term outcomes compared with open surgery

The Role of Hand-Assisted Laparoscopic Surgery in a Right Hemicolectomy for Right-Sided Colon Cancer

Minimally invasive esophagectomy for esophageal cancer: Comparative analysis of open and hand‐assisted laparoscopic abdominal lymphadenectomy with gastric conduit reconstruction

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